The classification of portal hypertension (PH) is derived from the location of the cause of PH. (ie. pre-hepatic, intra-hepatic and post hepatic). Intrahepatic PH is further divided into presinusoidal (eg liver fibrosis) or post sinusoidal (eg cirrhosis). An additional classification has recently been proposed called hyperdynamic PH(1). This includes arterio-venous fistulae and malformations. These give rise to the main components requiring systematic sonographic evaluation. These are the portal venous system, the liver parenchyma and the hepato-venous drainage
Portal Venous System
PH is identified by the evaluation of major organs (liver & spleen ), measurement of vein sizes (PV, SV and SMV) and assessment of spectral Doppler waveforms. Exclusion of thrombosis with careful b-mode and colour flow imaging is important. Much attention in clinical practise should be given to the identification of portosystemic venous collaterals.

Chronic Liver Disease
The presence and/or progression of chronic liver disease is an important part of the examination. Parenchymal heterogeneity, capsular nodularity with associated hepatic atrophy or hypertrophy is substantive evidence of advanced fibrosis or cirrhosis. An emphasis of this workshop will be the use of lower frequency linear transducers to show subtleties in the liver parenchyma that indicate earlier stages of fibrosis. The linear transducer is also very important in reviewing the ligamentum teres.

Hepatic Veins
Post hepatic PH (eg.Budd Chiari) needs to be excluded. Hepatic venous spectral can also be considered marker for chronic liver disease.

This workshop will use didactic presentation, interactive activities and live scanning to communicate these aspects of the examination.

1. Robinson KA, Middleton WD, Al-Sukaiti R, Teefey SA, Dahiya N. Doppler sonography of portal hypertension. Ultrasound Q. 2009 Mar;25(1):3-13.